Soriano V, Moreno-Torres V, Barreiro P
… +3 more, Álvarez C, Corral O, de Mendoza C
Expert Rev Anti Infect Ther
· 2025 Nov · PMID 41139222
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INTRODUCTION: HIV and hepatitis B continue to be global public health challenges. Each virus causes 1.2 million new infections annually. By 2025, roughly 40 million people live with HIV, and over 250 million have chronic...INTRODUCTION: HIV and hepatitis B continue to be global public health challenges. Each virus causes 1.2 million new infections annually. By 2025, roughly 40 million people live with HIV, and over 250 million have chronic hepatitis B. AREAS COVERED: Using PubMed, we analyzed approaches to control HIV and HBV epidemics. Whereas no vaccine exists to prevent HIV acquisition, successful protective HBV vaccines are available. The high incidence of HBV is largely explained by low immunization coverage and poor HBV screening. Linkage to care and sustained provision of antivirals remain suboptimal for HBV. New potent antiviral drugs and combinations are being developed. Long-acting formulations have shown clinical efficacy in HIV but remain untested for HBV. EXPERT OPINION: The WHO has called for eliminating both HIV and HBV as public health threats by 2030. Whereas the cascade of care for HIV is well rolled out at 80-80-80%s (diagnosed- treated-suppressed), rates are significantly lower for chronic hepatitis B (13-3-?), with only 7 million people treated. Major gaps exist at different stages of the hepatitis B cascade. There is a need to expand HBV vaccination and screening, as well as improve linkage to care and monitoring. Antiviral treatment should be provided earlier.
Charitos IA, Santacroce L, Topi S
… +3 more, Potenza MA, Montagnani M, Colella M
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 41135946
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INTRODUCTION: The community of microorganisms that colonize the intestine plays a vital role in regulating human metabolism and immune system function. According to translational medicine studies, administering antibioti...INTRODUCTION: The community of microorganisms that colonize the intestine plays a vital role in regulating human metabolism and immune system function. According to translational medicine studies, administering antibiotics disrupts the balance of microorganisms in the gastrointestinal system, increasing the risk of multiple diseases. Dysregulation and reduction of the biodiversity of intestinal microbiota increase the risk of developing unhealthy conditions for the host. In this review, we tried to offer a current vision regarding the use of antibiotics and the modification of the intestinal microbiota. AREAS COVERED: Research has also shown that, in addition to antibiotics, the composition and balance of the intestinal microbiota depend on diet from the first days of life (breastfeeding or formula) and the mode of delivery (vaginal birth or cesarean section). Having this in mind, we performed an extensive literature search in PubMed, Scopus, Embase, and Web of Science on the relationships between human microbiota and antibiotics. EXPERT OPINION: Effective antimicrobial stewardship programs are urgently needed to reduce the misuse of antibiotics to avoid bacteria becoming more resistant, resulting in the ineffectiveness of antibiotics. Alternatives to antibiotics, e.g., targeted probiotics or bacteriophages, are increasingly considered as a strategy to preserve the intestinal microbiota diversity and maintain a good health status.
Ruiz-Cobo JC, Palom A, Riveiro-Barciela M
… +1 more, Buti M
Expert Rev Anti Infect Ther
· 2025 Nov · PMID 41134660
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INTRODUCTION: Pegylated interferon alpha-2a (PEG-IFN) has been used off-label as chronic hepatitis delta (CHD) treatment since the 1990s. However, it has not received formal approval for this indication. Bulevirtide (BLV...INTRODUCTION: Pegylated interferon alpha-2a (PEG-IFN) has been used off-label as chronic hepatitis delta (CHD) treatment since the 1990s. However, it has not received formal approval for this indication. Bulevirtide (BLV), a first-in-class entry inhibitor, is the first drug approved for the treatment of compensated CHD. Since its conditional approval in 2020, data from clinical trials and real-world studies have emerged. Literature search included PubMed (last accessed July 2025), European Medicines Agency official reports, and international conference abstract books. AREAS COVERED: Several evidence gaps remain unmet, including the definition of treatment endpoints, the impact of therapy on clinical outcomes, optimal therapy duration, and the potential benefits of combination with PEG-IFN. This review aims to provide a comprehensive overview of the current evidence regarding the use of BLV, both as monotherapy and in combination with PEG-IFN. EXPERT OPINION: Bulevirtide 2 mg is an effective treatment for CHD in patients with and without advanced chronic liver disease, as demonstrated in clinical trials and real-world cohorts. In addition, long-term therapy appears to enhance response rates and may even promote the loss of HDV-infected hepatocytes, potentially leading to a sustained off-therapy response. However, new therapeutic strategies are needed for patients who do not respond.
Expert Rev Anti Infect Ther
· 2026 Mar · PMID 41123477
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INTRODUCTION: Tuberculous meningitis is frequently associated with significant mortality and persistent neurological sequelae. Diagnosis is often delayed due to nonspecific symptoms and the low sensitivity of cerebrospin...INTRODUCTION: Tuberculous meningitis is frequently associated with significant mortality and persistent neurological sequelae. Diagnosis is often delayed due to nonspecific symptoms and the low sensitivity of cerebrospinal fluid (CSF) tests. Standard pulmonary tuberculosis regimens are suboptimal for central nervous system involvement due to poor drug penetration and prolonged treatment. Emerging resistance, particularly to rifampicin and isoniazid, further complicates the management. AREAS COVERED: This review synthesizes recent data particularly on diagnostic tools, drug treatment, host-directed treatments, and supportive care in tuberculous meningitis. We summarize updated WHO recommendations and explore the pharmacokinetics and CSF penetration of antituberculosis drugs. Emphasis is placed on high-dose rifampicin, linezolid, and novel oxazolidinones such as sutezolid and delpazolid. Special populations, including children, pregnant women, those with human immunodeficiency virus, and drug-resistant disease are reviewed separately. The latest information of a variety of host-directed therapies is discussed. The utility of artificial intelligence for diagnosis and prognostication is also discussed. EXPERT COMMENTARY: Despite advances, tuberculous meningitis remains a clinical challenge. Early diagnosis, optimized dosing, and host-directed therapy are key priorities. Individualized regimens based on pharmacokinetics, drug resistance, and host factors are urgently needed. Precision diagnostics, new therapeutic agents, and artificial intelligence - driven tools may reduce mortality and improve outcomes.
Yonker LM, Dredge D, Munro A
… +3 more, Di Chiara C, Cotugno N, Buonsenso D
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 41087378
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INTRODUCTION: SARS-CoV-2 can have long-term health consequences that persist beyond acute infection. While this is evident in adults and the elderly, the impact on children and adolescents remains under recognized. Here...INTRODUCTION: SARS-CoV-2 can have long-term health consequences that persist beyond acute infection. While this is evident in adults and the elderly, the impact on children and adolescents remains under recognized. Here we navigate the second-order post-acute effects that the COVID-19 has had on the pediatric populations, with the exception of the mental health implication of social restrictions. AREAS COVERED: We outline common scenarios related with SARS-CoV-2 infection encountered in pediatric clinical practice, such as in the Multisystem inflammatory syndrome (MIS-C), Long Covid, neurological and autoimmune complications of Covid-19, immunological impact of the viral infection, as well as epidemiological and public health consequences associated with the implementation of non-pharmacological interventions. EXPERT OPINION: SARS-CoV-2 has had several second-order effects on child health, from a biological, epidemiological, and public health perspective, highlighting the complexity of dealing with new infections and the urgent need to implement multidisciplinary interventions that support the health of people at single person and societal level. Funding on modern surveillance system, preventing strategies and research to better understand and cure post-acute complications of viral infections should be a priority of every funding agency.
Castagnola E, Mariani M, Ricci E
… +3 more, Russo C, Saffioti C, Mesini A
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 41077816
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INTRODUCTION: Invasive fungal diseases (IFD) cause significant morbidity and mortality in children, who have unique risk factors like premature birth, genetic conditions, and immunodeficiencies. They also share adult ris...INTRODUCTION: Invasive fungal diseases (IFD) cause significant morbidity and mortality in children, who have unique risk factors like premature birth, genetic conditions, and immunodeficiencies. They also share adult risk factors, such as antineoplastic treatments and intensive care. This narrative review summarizes epidemiology and focus on diagnosis, and treatment of IFD in pediatric patients. AREA COVERED: Diagnosing IFD in children is challenging due to the difficulties in obtaining sufficient blood or CSF for cultures from small patients. Additionally, antigen detection methods often perform poorly, except perhaps beta-glucan in newborns and galactomannan in neutropenic patients or samples from the infection site. Nonspecific imaging findings further complicate diagnosis. Therapeutic complexities arise from age- or disease-dependent pharmacokinetics, limited availability of child-friendly drug formulations, and frequent drug-drug and food-drug interactions, often requiring therapeutic drug monitoring for optimal outcomes. EXPERT OPINION: There is and will be further needed therapeutic drug monitoring for all antifungal drugs in children. Prioritizing pediatric-specific research and developing standardized treatment protocols are crucial. Furthermore, regulatory reforms are essential to expedite access to new diagnostic and treatment strategies for IFD in children.
Pariano M, Puccetti M, Fabi C
… +7 more, Nunzi E, Balucchi S, Perioli L, Ricci M, Giovagnoli S, Garaci E, Romani L
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 41048103
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INTRODUCTION: Candidiasis comprises a spectrum of infections ranging from superficial mucosal to life-threatening systemic infections caused by the opportunistic yeast, , a genus containing several species of heterogeneo...INTRODUCTION: Candidiasis comprises a spectrum of infections ranging from superficial mucosal to life-threatening systemic infections caused by the opportunistic yeast, , a genus containing several species of heterogeneous behavior and unique pathogenesis in the human host. is the most prevalent species. The aim of this review is to provide an update on pathogenesis, resistance and emerging therapeutic strategies in candidiasis, with a focus on . AREAS COVERED: We discuss recent advancements that have deepened our understanding of pathogenesis, particularly the roles of morphological plasticity, metabolic flexibility, biofilm formation, multidrug resistance and gut dysbiosis. We interrogated three major databases, mainly PubMed, Scopus and Google Scholar for the latest (with emphasis on the works published in the last 5 years) developments in antifungal resistance trends, diagnostic innovations, and novel therapeutic strategies, including next-generation antifungals, combination therapies and nanopharmaceuticals. Additionally, we explore emerging strategies, such as probiotics, vaccines, and antifungal stewardship, and discuss the impact of post-COVID-19 immunosuppression, cancer therapies, and climate change on candidiasis epidemiology. EXPERT OPINION: The future of management lies in personalized approaches, leveraging genomics, host-pathogen interactions and advanced drug-delivery platforms to combat resistance, overcome the limitations of current systemic therapy and improve patient outcomes.
Elezbawy B, Abaza N, Fasseeh M
… +13 more, Elshahawy R, S Mahmoud Y, Hendawy H, Konstantinov SR, Ruiz-Guiñazú J, Willame C, Geurtsen J, Poolman J, Voko Z, Nagy D, Zelei T, Kovács S, Lohner S
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 41048094
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INTRODUCTION: Postoperative Staphylococcus aureus (S. aureus) infections are associated with increased morbidity and mortality. This systematic review and meta-analysis aimed to summarize the incidence of postoperative S...INTRODUCTION: Postoperative Staphylococcus aureus (S. aureus) infections are associated with increased morbidity and mortality. This systematic review and meta-analysis aimed to summarize the incidence of postoperative S. aureus infections. METHODS: We searched MEDLINE, CENTRAL, and Embase (2008-2023) for studies reporting S. aureus infections after hip or knee replacement, spinal surgery, craniotomy, coronary artery bypass surgery (CABG), open colon surgery, abdominal hysterectomy, cesarean section, peripheral vascular bypass, or elective plastic surgery in selected developed countries were considered. We conducted meta-analysis with a generalized linear mixed model and assessed risk of bias. This study is registered with PROSPERO,CRD42023416876. RESULTS: Data from 224 studies indicated a cumulative incidence of deep S. aureus infection after hip surgery 5.05 infections/1000 procedures (95% CI 3.29-7.74), 5.59 (95% CI 3.62-8.63) after knee surgery, 11.74 (95% CI 9.08-15.16) after spinal surgery, and 7.23 (95% CI 1.63-31.86) after CABG surgery. S. aureus infections were associated with increased all-cause mortality among CABG, hip, knee, and spinal surgeries. Patients cohorts who received antibiotic prophylaxis and/or underwent decolonization demonstrated lower incidence of S. aureus infections. CONCLUSIONS: The incidence of S. aureus infections varies by procedure, with highest rates seen after spinal surgeries and hysterectomies. Findings highlight the importance of standardized prevention across surgical settings.
Gorham J, Yousfi H, Taccone FS
… +2 more, Salvagno M, Hites M
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 41026939
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INTRODUCTION: Central nervous system (CNS) infections are a health concern, leading to high morbidity and mortality. Community-acquired and nosocomial meningitis are distinct entities with potentially different pathogens...INTRODUCTION: Central nervous system (CNS) infections are a health concern, leading to high morbidity and mortality. Community-acquired and nosocomial meningitis are distinct entities with potentially different pathogens involved. Prompt antibiotic therapy is crucial. However, challenges arise due to the emergence of multidrug-resistant bacteria and the poor CNS penetration of most antibiotics. AREAS COVERED: This review summarizes the pathogenesis of bacterial CNS infections, the pharmacokinetics, and pharmacodynamics of several classes of antibiotics within the cerebrospinal fluid (CSF) and the optimal treatment of these infections in adults. A literature search was performed in PubMed and Embase including all available articles up to February 2025. EXPERT OPINION: The selection of antibiotics with proven CNS penetration and activity against the suspected or confirmed pathogens is essential, particularly in the context of emerging resistance. Higher daily doses and continuous or extended infusions (CI/EI) help maintain therapeutic concentrations in critically ill patients, while intrathecal (IT) administration of antibiotics should be considered when systemic therapy alone is insufficient. Therapeutic drug monitoring (TDM) is crucial for optimizing dosing, especially for drugs with narrow therapeutic indices. Although CSF TDM remains uncommon and challenging, it should be performed in specialized centers with experience in antibiotic pharmacokinetics.
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 40957868
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INTRODUCTION: Urinary tract infection (UTI) is the most common infectious complication in kidney transplant recipients (KTRs). Beyond attributable morbidity and related costs, post-transplant UTI appears to exert a delet...INTRODUCTION: Urinary tract infection (UTI) is the most common infectious complication in kidney transplant recipients (KTRs). Beyond attributable morbidity and related costs, post-transplant UTI appears to exert a deleterious effect on graft outcomes. Uncertainties on the significance of asymptomatic bacteriuria (ASB) and the increasing role as uropathogens of multidrug-resistant organisms (MDROs) further complicate the therapeutic approach. AREAS COVERED: Following a contextualizing introduction on the epidemiology, risk factors and consequences of post-transplant UTI, we reviewed the rationale underlying the 'screen-and-treat' strategy for ASB and the recently generated evidence. Most appropriate regimens for the empirical treatment of cystitis and pyelonephritis are discussed in light of recent microbiological trends. The role of novel antibiotics against MDROs is considered, as well as the management of recurrent UTI and the feasibility of dedicated antibiotic stewardship programs (ASPs). Finally, future directions and unmet needs are addressed in the present narrative review. EXPERT OPINION: Despite advances to clarify the management of ASB and recent additions to the antibiotic armamentarium, research is needed to optimize the empirical and definitive therapy for post-transplant UTI. This should include the validation of predictive scores for MDRO infection, the effectiveness and safety of novel antibiotics, and the implementation of ASPs in KTRs.
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 40874873
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INTRODUCTION: Cryptococcal meningitis (CM) is the second leading cause of AIDS-related mortality where the burden of advanced HIV disease is concentrated. Advances in diagnostics and treatment, including cryptococcal ant...INTRODUCTION: Cryptococcal meningitis (CM) is the second leading cause of AIDS-related mortality where the burden of advanced HIV disease is concentrated. Advances in diagnostics and treatment, including cryptococcal antigen (CrAg) screening and short-course antifungal regimens, have improved clinical outcomes in trials, but replicating these same benefits in routine care has proven more difficult. AREAS COVERED: This review outlines the biological rationale for CrAg screening and examines the major operational barriers to effective CM diagnosis in low-income countries. An exploratory literature review identified peer-reviewed articles published before May 2025. We assess challenges for CD4 testing, CrAg screening, lumbar puncture (LP) performance, and routine surveillance. Novel approaches, including risk stratification with semi-quantitative CrAg testing are also described. EXPERT OPINION: The impact of recent diagnostic and treatment advances for cryptococcal disease has been constrained by gaps in implementation. Closing the diagnostic gap requires strengthening decentralized CD4 testing; expanding reflex and point-of-care CrAg, including use of semi-quantitative CrAg assays to prioritize those at highest risk for urgent LP and/or enhanced antifungal treatment; strengthening healthcare provider training, referral systems, LP access, and enhancing community engagement. Integration of these measures into national HIV programs alongside operational research could reduce mortality for patients and costs for health systems.
INTRODUCTION: Diagnostic stewardship, the optimization of diagnostic testing to improve patient outcomes, is a rapidly evolving field; however, data relating to immunocompromised hosts are scarce. AREAS COVERED: This rev...INTRODUCTION: Diagnostic stewardship, the optimization of diagnostic testing to improve patient outcomes, is a rapidly evolving field; however, data relating to immunocompromised hosts are scarce. AREAS COVERED: This review examines recent advances in diagnostic stewardship and explores best practice principles for key clinical scenarios in immunocompromised patients, including febrile neutropenia, central nervous system infections, invasive fungal infections, cytomegalovirus, and infection. EXPERT OPINION: Key challenges remain, including optimizing test utilization without compromising patient safety, interpreting advanced diagnostics in the context of immunosuppression, and demonstrating cost-effectiveness. A multidisciplinary approach incorporating both diagnostic and antimicrobial stewardship principles is essential to improve outcomes in this complex patient population. Future research should focus on prospective evaluation of diagnostic stewardship interventions and their impact on clinical and economic outcomes in immunocompromised hosts.
Wójcicki M, Cieślik M, Haraźna K
… +3 more, Sobczak-Kupiec A, Górski A, Jończyk-Matysiak E
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 40747965
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INTRODUCTION: Catheter-associated urinary tract infections (CAUTIs) are among the most prevalent hospital-acquired infections, posing a serious clinical and economic burden, particularly in the context of rising antibiot...INTRODUCTION: Catheter-associated urinary tract infections (CAUTIs) are among the most prevalent hospital-acquired infections, posing a serious clinical and economic burden, particularly in the context of rising antibiotic resistance. Biofilm formation on indwelling catheters by multidrug-resistant uropathogens further complicates treatment and prevention, underscoring the urgent need for alternative, non-antibiotic solutions. AREAS COVERED: This article explores the potential of bacteriophage- and enzybiotic-coated urinary catheters as an innovative strategy to prevent recurrent bacterial infections. We review the clinical significance of biofilm formation on the surface of urinary catheters, the role of phages and their lytic enzymes in disrupting biofilms, and the clinical evidence supporting the efficacy of phage therapy. The reference list was compiled through a structured search of peer-reviewed studies and case reports, particularly from recent years, available in the PubMed database. EXPERT OPINION: Phage- and enzybiotic-functionalized catheters represent a promising non-antibiotic approach to CAUTI prevention. These biological agents offer targeted antibacterial activity, disrupt biofilms, and reduce the risk of drug resistance development. Their integration into catheter design may significantly improve infection control, reduce antibiotic use, and align with global antimicrobial stewardship goals. However, clinical standardization and regulatory clarity are crucial for advancing their implementation in routine clinical practice.
Chen YC, Dhillon S, Adomakoh N
… +1 more, Roberts JA
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 40739989
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INTRODUCTION: The global burden of invasive fungal infections (IFIs) is increasing, with the threat of disease exacerbated by the emergence of antifungal resistance. While antifungals remain the mainstay for the treatmen...INTRODUCTION: The global burden of invasive fungal infections (IFIs) is increasing, with the threat of disease exacerbated by the emergence of antifungal resistance. While antifungals remain the mainstay for the treatment of IFIs, there is a growing recognition of the many patient variables, particularly in challenging situations (e.g. critically ill patients), that can impact the exposure of antifungals. AREAS COVERED: This narrative review focuses on the changing epidemiology of species in Asia Pacific and evidence for optimizing antifungal dosing in challenging clinical scenarios, based on a symposium held at the International Society for Human and Animal Mycology Asia Congress in Bangkok, Thailand, on 1 August 2024. EXPERT OPINION: Antifungal resistance is common and increasing among fungal pathogens (e.g. species) in the Asia Pacific. Optimal drug selection and dosing of antifungals is critical for achieving the best therapeutic outcomes and limiting resistance emergence, particularly in challenging clinical scenarios. Current 'standard' doses of antifungals do not account for pharmacokinetic variations in critically ill patients and can lead to suboptimal exposures, highlighting the need for better dosing regimens in these patients. Therapeutic drug monitoring is a valuable strategy for optimizing antifungal therapy, and its use is encouraged, particularly in critically ill patients.